Medical Humanities … in practice

There’s an interesting debate going on in the BMJ forum. A psychiatrist is lamenting a management decision to show patients Milos Forman’s 1975 film One Flew Over the Cuckoo’s Nest, based (loosely) on Ken Kesey’s 1962 novel of the same name (itself based loosely on Kesey’s experiences working on a US psychiatric ward in the 1950s).

Apparently, the film is being shown as a ‘rehab’ tool, but almost all the clinicians commenting in the forum think that this is: ‘dangerous’; ‘scary’; ‘unprofessional’ and – without irony – ‘madness’.

Criticism of the decision seems mainly to focus on the anachronistic nature of the representation of mental health care. Simply put: 1950s US treatment tells us nothing about 21st century UK treatment.

I’m not certain that is true. Good art – or less pompously, good storytelling and characterisation – always transcends historical context. The (artistic) truth speaks across the decades, or the centuries. An obvious example: the psychological woes and worries of a Danish prince continue to console and beguile audiences 400 years since first performed.

That’s not to say that there aren’t serious problems with One Flew Over the Cuckoo’s Nest (1975). For example, the representations of women and African-Americans must have seemed (to be polite) ‘dated’ even at the time. Similarly, the collective compositional Gestus of the chronically mentally ill seems hardly more nuanced than that in the final painting of Hogarth’s A Rake’s Progress. Insulting perhaps, patronising certainly, but dangerous? Dangerous to whom?

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7 comments on “Medical Humanities … in practice”

Hannah Winfield

6 June, 2012

What is the rationale for showing the film in the first place – how is it meant to aid rehab? It seems really ill-thought out to me. My concern would be how the staff are portrayed, in particular Nurse Ratched. She’s almost a demonic figure. It doesn’t give the impression that staff are interested in or focussed on the needs of patients at all. Maybe that is what concerns the psychiatrist? It doesn’t really engender a spirit of collaboration between staff and patients..

Sure. A discussion could be helpful about these power issues but you’d have to be quite well to be at the stage of that being possible. If you’re in hospital, you’re probably not well enough – symptoms are too active. It’s cruel. And dangerous possibly yes – in the sense of making people worse and possibly unmanageable. I don’t think it fits within the duty of care. I think the idea behind wards is that people feel safe so that they can start to feel better (they often don’t achieve this, I know). But this feels like it could move actively in the opposite direction.

I think Hannah has raised some excellent points, and that the rationale for showing ANY film in a forensic setting to “acute” patients needs to be pretty carefully explained. I’m all for people watching films, but is this supposed to be an exercise in entertainment, a demonstration of empathy, a provocation, a statement about how things currently are, an invitation to develop skills in culturally contextualised film theory or something else entirely?

While I don’t dispute that the cultural artefacts of other historical periods have plenty of valuable things to offer, I do get exasperated by the fact that so many people (medical and health humanities scholars among them!) treat the mythologizing and now mythologized Cuckoo’s Nest as some kind of masterpiece at the expense of exploring other films and indeed other modes of representation. Perhaps once psychiatrists and patients have worked out what they want to achieve in forensic screenings we might be able to suggest some more engaging examples?